Risk and protective factors for emergency department visits and related hospitalizations among ambulatory adults with traumatic spinal cord injury.

Abstract

Objective: To identify the risk and protective factors for emergency department visits (EDV) and inpatient admissions through the ED (EDIP) among a population-based cohort of ambulatory adults with spinal cord injury (SCI).

Design: Prospective self-report cohort study linked to administrative billing data.

Setting: A Medical University in the Southeastern USA.

Participants: 656 ambulatory adults (>18 years old) with chronic (>1-year), traumatic SCI identified through a statewide population-based registry.

Outcome measures: EDV and EDIP in non-federal state hospitals in the year following self-report.

Results: In the final model, lower rates of future EDV were associated with being older (incidence rate ratio, IRR = 0.99), greater time since injury (IRR = 0.94), and higher income (IRR = 0.89). The EDV rate among non-white individuals was 1.49 times as high as white individuals (P = 0.01). Higher rates of future EDV were associated with using prescription medications for pain, spasticity, sleep, and stress (IRR = 1.30), having depression (IRR = 1.16) and a greater number of chronic conditions (IRR = 1.13), and more past year urinary tract infections (IRR = 1.32), upper extremity broken bones (IRR = 1.37), and serious injuries (IRR = 1.20). Factors associated with higher rates of future EDIP included urban location (IRR = 2.07), higher levels of education (IRR = 1.85), and having a current pressure injury (IRR = 2.94). Married or coupled individuals (IRR = 0.48), and those who reported more days per month of inadequate sleep had lower rates of EDIP (IRR = 0.96).

Conclusions: Several preventable health related factors were significantly related to EDV. The study findings may help clinicians predict and prevent EDV, empower stakeholders for better self-management of their health, and inform decisions to promote the reduction of costly EDV and EDIP.